Provider Demographics
NPI:1639580871
Name:LUFF, GENNEVIEVE (MA)
Entity Type:Individual
Prefix:MRS
First Name:GENNEVIEVE
Middle Name:
Last Name:LUFF
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:GENNEVIEVE
Other - Middle Name:
Other - Last Name:WREDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 2ND AVE NE STE 201
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3011
Mailing Address - Country:US
Mailing Address - Phone:253-888-3276
Mailing Address - Fax:253-329-5051
Practice Address - Street 1:301 2ND AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372
Practice Address - Country:US
Practice Address - Phone:253-888-3276
Practice Address - Fax:253-329-5051
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60822903101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health